|“My child has a bump on (or near) his eye.”|
|Infantile capillary hemangioma|
|Initially noted in first few weeks of life|
|Grows rapidly in first 1 to 2 months|
|Present at birth (though may not be noticed
|Most commonly located at superolateral orbit|
|Present at or shortly after birth|
|Mass on medial canthus|
|May have symptoms of lacrimal obstruction|
|If large, associated nasal cyst may cause respiratory
|Initial eyelid erythema (may mimic cellulitis)|
|Usually evolves into discrete nodule|
|Infantile capillary hemangioma|
|If subcutaneous, vascular character may not
|May have hemangiomas elsewhere on the body|
|Smooth, firm, subcutaneous nodule|
|Most commonly located at superotemporal orbital
|Usually blue-tinged mass overlying lacrimal
|If infected, becomes erythematous|
|May have periocular crusts, discharge|
|Initially may have diffuse eyelid swelling and
erythema (may mimic cellulitis)|
|Usually develop erythematous nodule, often with
|May drain spontaneously|
|If chronic, usually firm nodule|
|May have multiple, recurrent lesions|
|Blepharitis common (crusts of lashes, erythematous
Infants with noninfected mucoceles should be treated with warm
compresses and topical antibiotics. If the lesion does not resolve,
or if the mucocele becomes infected, referral to a pediatric ophthalmologist
Infants with hemangiomas involving the eyelids or periocular
structures should be referred to a pediatric ophthalmologist due
to the risk of amblyopia.
Styes and chalazia should be treated initially with warm compresses.
Topical antibiotics may also be used. Most resolve with conservative
treatment in 1 to 2 months. If they do not, referral for incision
and drainage may be indicated.
Infantile mucoceles are almost always associated with nasolacrimal
duct cysts. If these are large, they may cause respiratory difficulties.
These patients require prompt nasal endoscopy and removal of the
- 1. Hemangioma. Hemangiomas
are vascular lesions that develop within the first few weeks of
life. They usually go through a fairly rapid growth phase over the
next few months, then slowly involute. The lesions themselves are
benign, but periocular hemangiomas can cause amblyopia, either due
to obstruction of vision or by inducing astigmatism (Figure 13–1).
- 2. Orbital dermoids. Orbital
dermoids are benign lesions that arise from entrapment of ectodermal
tissue between the growth plates during the embryological development
of the skull. They are most commonly located along the superolateral
orbital rim (Figure 13–2). They may rupture, which can
incite a marked inflammatory response.
- 3. Mucocele (dacryocele, dacryocystocele,
amniotocele). These lesions result from dilation of the lacrimal
sac in newborns with lacrimal obstruction. They present as blue-tinged
masses overlying the lacrimal sac between the eye and ...
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